Provider Demographics
NPI:1396409215
Name:BORAD, KOMAL B
Entity Type:Individual
Prefix:
First Name:KOMAL
Middle Name:B
Last Name:BORAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10490 RANCHO CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3666
Mailing Address - Country:US
Mailing Address - Phone:619-538-7144
Mailing Address - Fax:
Practice Address - Street 1:11588 VIA RANCHO SAN DIEGO
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-5277
Practice Address - Country:US
Practice Address - Phone:619-375-0419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist